Sample Treatment Plan Update

This is a fictitious case. All names used in the document are fictitious. Sample Treatment plan Update Recipient Information Provider Information Medicaid Number:123456789 Medicaid Number:987654321 Name: Jill Spratt Name: Tom Thumb, DOB: 9-13-92 Treatment plan Date: 10-9-06 Treatment plan Review Date: 3-19-07 Other Agencies Involved: plan to Coordinate Services: Jack Horner, , Child Psychiatrist As needed, but at least 1 time every 3 months. Spring Hill Middle School Contact by phone as needed. Diagnoses: Axis I: Major Depressive Disorder, Single Episode, in Partial Remission Parent-Child Relational Problem Axis II: No diagnosis Axis III: No diagnosis Axis IV: Problems with Primary Support Group Axis V: 61 Justification for Diagnosis Change: Primary diagnosis has been changed from Major Depressive Disorder, Single Episode, Moderate, to Major Depressive Disorder, Single Episode, in Partial Remission to reflect the progress Jill has made.

3. Jill will report no suicidal ideation for 3 consecutive weeks 4. Jill will learn coping skills, including problem solving and emotional regulation. This will be measured by her demonstrating these skills during therapy sessions and bringing in homework assignments for two consecutive Date Established 10-9-06 10-9-06 10-9-06 10-9-06 Projected

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  Treatment, Plan, Suicidal, Treatment plan

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